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Operation with a single-channel thin-fibre arthroscope in patients with internal derangement of the temporomandibular joint
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British Journal of Oral and Maxillofacial Surgery 46 (2008) 313–314
Short communication
Operation with a single-channel thin-fibre arthroscope in patients with internal derangement of the temporomandibular joint H. Yoshida a,∗ , Y. Fukumura b , I. Tojyo c , A. Yamaguchi c , K. Tsuji a , J. Sako a , K. Yamada a , S. Morita a a b c
First Department of Oral and Maxillofacial Surgery, Osaka Dental University, 1-5-17, Otemae, Chuo-ku, Osaka, 540-0008 Japan Department of Oral and Maxillofacial Surgery, Fukui Prefectural Hospital, Fukui, Japan Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayam, Japan
Accepted 31 May 2007 Available online 19 July 2007
Abstract We evaluated the use of operation by single-puncture arthroscopy in 55 patients (62 joints) with locked temporomandibular joints (TMJ). We used a single-channel thin-fibre arthroscope (M & M Co., Tokyo, Japan) and a holuminium yttrium aluminium garnet (Ho:YAG) laser (Lumenis Co., Tokyo, Japan). The preoperative mean (SD) maximum interincisal measurement (distance between the edge of the lower and upper incisor) was 26.0 (4.9) mm, and it was increased by 15.0 mm 12 weeks after operation. The preoperative mean (SD) visual analogue score (VAS) was 6.3(2.0), and after 12 weeks it had been reduced to 1.6 (1.1). There were no other complaints. Single-puncture arthroscopy with the Ho:YAG laser is simple and useful. There were no other complications, and the results obtained were satisfactory. © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Single-puncture arthroscopy; Temporomandibular joint; Single-channel thin-fibre; Holuminium yttrium aluminium garnet (Ho:YAG) laser
Introduction We have evaluated the use of single-puncture arthroscopy (M & M Co., Tokyo, Japan)1,2 with a holuminium yttrium aluminium garnet laser (Lumenis Co. Tokyo, Japan)3 with chronic locked temporomandibular joints (TMJ).4
Patients and methods Fifty-five patients with 62 joints were selected for this study, using the criteria: mouth opening limited to <32 mm for ∗
Corresponding author. Tel.: +81 6 6910 1076; fax: +81 6 6910 1028. E-mail address: [email protected] (H. Yoshida).
more than 6 weeks; anterior disc displacement without reduction on magnetic resonance imaging (MRI); and those who failed to respond to treatment. Ankylosis of the TMJ was excluded. The duration of symptoms ranged from 8 to 124 weeks (mean 27), and the duration of locking from 8–42 weeks (mean 17). The pain score (visual analogue; VAS, range 0–10), maximum mouth opening (interincisal distance in mm), complications, and histopathological findings were recorded. The patients had TMJ arthroscopic lavage and lysis under general anaesthesia with the single-channel thin fibre and Ho:YAG laser (Figs. 1 and 2), with about 500 ml of saline solution as the lavage fluid. After the diagnostic arthroscopy, we removed and sculpted the diseased tissues (synovectomy
0266-4356/$ – see front matter © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2007.05.010
314
H. Yoshida et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 313–314
Interincisal measurement Preoperative mean (SD) maximum interincisal measurement was 26.0 (4.9) mm, a week after operation it was 37.1 (4.2) mm, 6 weeks after operation it was 39.3 (3.9) mm, and 12 weeks after operation it was 41.2 (3.3) mm. Three patients (four joints) who reported no change in pain or no improvement in mouth opening, or both, after operation, had perforated discs and severe osteoarthrosis arthroscopically. No articular damage was done by the arthroscopy or laser lysis.
Fig. 1. Cross-section of thin-solid-fibre arthroscope showing internal arrangement.
Discussion In 1986, Sanders described a simple method (single puncture) of lysis and lavage of the TMJ. It has been widely used, and several investigators have reported on its efficacy and non-invasiveness.5 The Ho:YAG laser has several potential advantages: it causes rapid coagulation in the synovitic area without thermal damage, and it penetrates tissue to a depth of only 0.5 mm or less, so minimising trauma to the synovial surfaces and to adjacent tissues. Iatrogenic damage should therefore be minimal. Because of their small tips, lasers can be used effectively to cut and ablate the narrow joint space. The fibrous adhesions and synovitis are cauterised and incised with the Ho:YAG.6,7 With the simple puncture system, it was easy to apply the exact degree of radiation because the laser could be inserted through the inner channel of the scope. Complications were few and patients were satisfied.
References Fig. 2. The operation using the single-channel thin-fibre in the TMJ.
or incision of fibrous adhesion) with the Ho:YAG laser, and released them laterally. For postoperative assessment we recorded a VAS for pain, interincisal measurement for mandibular function, and a questionnaire for satisfaction. All data were collected before and after operation. Patients were assessed at 1, 6, and 12 weeks after operation.
Results VAS for pain The mean (SD) preoperative pain score was 6.3 (2.0), 1 week after operation it was 3.1 (1.9), after 6 weeks it was 1.8 (1.2), and after 12 weeks it was 1.6 (1.1).
1. Ohnishi M. Newly designed needle scope system for the arthroscopic surgery by double-channel sheath method (in Japanese). Nihon Ago Kansetsu Gattai Zasshi 1989;1:209–16. 2. Kurita K, Ogi N, Toyama M, Maki I, Ike M. Single-channel thin-fiber and Nd:YAG laser temporomandibular joint arthroscope: development and preliminary clinical findings. Int J Oral Maxillofac Surg 1997;26:414–8. 3. Israel HA. Part I: The use of arthroscopic surgery for treatment of temporomandibular joint disorders. J Oral Maxillofac Surg 1999;57:579–82. 4. Yoshida H, Fukumura Y, Suzuki S, et al. Simple manipulation therapy for temporomandibular joint internal derangement with closed lock. Asian J Oral Maxillofac Surg 2005;17:256–60. 5. Sanders B. Arthroscopic surgery of the temporomandibular joint: treatment of internal derangements with persisent closed lock. Oral Surg Oral Med Oral Pathol 1986;62:361–72. 6. Mazzonetto R, Spagnoli DB. Long-term evaluation of arthroscopic discectomy of the temporomandibular joint using the Holmium YAG laser. J Oral Maxillofac Surg 2001;59:1018–23. 7. Kaneyama K, Segami N, Sato J, Murakami K, Iizuka T. Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium:YAG laser or electrocautery. Oral Surg Oral Med Oral Pathol 2004;97:546–52.
British Journal of Oral and Maxillofacial Surgery 46 (2008) 313–314
Short communication
Operation with a single-channel thin-fibre arthroscope in patients with internal derangement of the temporomandibular joint H. Yoshida a,∗ , Y. Fukumura b , I. Tojyo c , A. Yamaguchi c , K. Tsuji a , J. Sako a , K. Yamada a , S. Morita a a b c
First Department of Oral and Maxillofacial Surgery, Osaka Dental University, 1-5-17, Otemae, Chuo-ku, Osaka, 540-0008 Japan Department of Oral and Maxillofacial Surgery, Fukui Prefectural Hospital, Fukui, Japan Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayam, Japan
Accepted 31 May 2007 Available online 19 July 2007
Abstract We evaluated the use of operation by single-puncture arthroscopy in 55 patients (62 joints) with locked temporomandibular joints (TMJ). We used a single-channel thin-fibre arthroscope (M & M Co., Tokyo, Japan) and a holuminium yttrium aluminium garnet (Ho:YAG) laser (Lumenis Co., Tokyo, Japan). The preoperative mean (SD) maximum interincisal measurement (distance between the edge of the lower and upper incisor) was 26.0 (4.9) mm, and it was increased by 15.0 mm 12 weeks after operation. The preoperative mean (SD) visual analogue score (VAS) was 6.3(2.0), and after 12 weeks it had been reduced to 1.6 (1.1). There were no other complaints. Single-puncture arthroscopy with the Ho:YAG laser is simple and useful. There were no other complications, and the results obtained were satisfactory. © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Single-puncture arthroscopy; Temporomandibular joint; Single-channel thin-fibre; Holuminium yttrium aluminium garnet (Ho:YAG) laser
Introduction We have evaluated the use of single-puncture arthroscopy (M & M Co., Tokyo, Japan)1,2 with a holuminium yttrium aluminium garnet laser (Lumenis Co. Tokyo, Japan)3 with chronic locked temporomandibular joints (TMJ).4
Patients and methods Fifty-five patients with 62 joints were selected for this study, using the criteria: mouth opening limited to <32 mm for ∗
Corresponding author. Tel.: +81 6 6910 1076; fax: +81 6 6910 1028. E-mail address: [email protected] (H. Yoshida).
more than 6 weeks; anterior disc displacement without reduction on magnetic resonance imaging (MRI); and those who failed to respond to treatment. Ankylosis of the TMJ was excluded. The duration of symptoms ranged from 8 to 124 weeks (mean 27), and the duration of locking from 8–42 weeks (mean 17). The pain score (visual analogue; VAS, range 0–10), maximum mouth opening (interincisal distance in mm), complications, and histopathological findings were recorded. The patients had TMJ arthroscopic lavage and lysis under general anaesthesia with the single-channel thin fibre and Ho:YAG laser (Figs. 1 and 2), with about 500 ml of saline solution as the lavage fluid. After the diagnostic arthroscopy, we removed and sculpted the diseased tissues (synovectomy
0266-4356/$ – see front matter © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2007.05.010
314
H. Yoshida et al. / British Journal of Oral and Maxillofacial Surgery 46 (2008) 313–314
Interincisal measurement Preoperative mean (SD) maximum interincisal measurement was 26.0 (4.9) mm, a week after operation it was 37.1 (4.2) mm, 6 weeks after operation it was 39.3 (3.9) mm, and 12 weeks after operation it was 41.2 (3.3) mm. Three patients (four joints) who reported no change in pain or no improvement in mouth opening, or both, after operation, had perforated discs and severe osteoarthrosis arthroscopically. No articular damage was done by the arthroscopy or laser lysis.
Fig. 1. Cross-section of thin-solid-fibre arthroscope showing internal arrangement.
Discussion In 1986, Sanders described a simple method (single puncture) of lysis and lavage of the TMJ. It has been widely used, and several investigators have reported on its efficacy and non-invasiveness.5 The Ho:YAG laser has several potential advantages: it causes rapid coagulation in the synovitic area without thermal damage, and it penetrates tissue to a depth of only 0.5 mm or less, so minimising trauma to the synovial surfaces and to adjacent tissues. Iatrogenic damage should therefore be minimal. Because of their small tips, lasers can be used effectively to cut and ablate the narrow joint space. The fibrous adhesions and synovitis are cauterised and incised with the Ho:YAG.6,7 With the simple puncture system, it was easy to apply the exact degree of radiation because the laser could be inserted through the inner channel of the scope. Complications were few and patients were satisfied.
References Fig. 2. The operation using the single-channel thin-fibre in the TMJ.
or incision of fibrous adhesion) with the Ho:YAG laser, and released them laterally. For postoperative assessment we recorded a VAS for pain, interincisal measurement for mandibular function, and a questionnaire for satisfaction. All data were collected before and after operation. Patients were assessed at 1, 6, and 12 weeks after operation.
Results VAS for pain The mean (SD) preoperative pain score was 6.3 (2.0), 1 week after operation it was 3.1 (1.9), after 6 weeks it was 1.8 (1.2), and after 12 weeks it was 1.6 (1.1).
1. Ohnishi M. Newly designed needle scope system for the arthroscopic surgery by double-channel sheath method (in Japanese). Nihon Ago Kansetsu Gattai Zasshi 1989;1:209–16. 2. Kurita K, Ogi N, Toyama M, Maki I, Ike M. Single-channel thin-fiber and Nd:YAG laser temporomandibular joint arthroscope: development and preliminary clinical findings. Int J Oral Maxillofac Surg 1997;26:414–8. 3. Israel HA. Part I: The use of arthroscopic surgery for treatment of temporomandibular joint disorders. J Oral Maxillofac Surg 1999;57:579–82. 4. Yoshida H, Fukumura Y, Suzuki S, et al. Simple manipulation therapy for temporomandibular joint internal derangement with closed lock. Asian J Oral Maxillofac Surg 2005;17:256–60. 5. Sanders B. Arthroscopic surgery of the temporomandibular joint: treatment of internal derangements with persisent closed lock. Oral Surg Oral Med Oral Pathol 1986;62:361–72. 6. Mazzonetto R, Spagnoli DB. Long-term evaluation of arthroscopic discectomy of the temporomandibular joint using the Holmium YAG laser. J Oral Maxillofac Surg 2001;59:1018–23. 7. Kaneyama K, Segami N, Sato J, Murakami K, Iizuka T. Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium:YAG laser or electrocautery. Oral Surg Oral Med Oral Pathol 2004;97:546–52.